At age 5, my son’s T-tooth pits and cracks developed cavities. My prevention-focused heart was so frustrated with myself as I was responsible for his oral health care. The caries had spread rapidly and required a pulpotomy, and six months later an abscess developed and required extraction, with a spacer placed.
Watching my child go through this was heartbreaking and helped me develop empathy for other parents. This made me want to prevent this from happening to other children and parents. What were my options for preventing caries in the cavities and fissures of primary molars? Would putting sealant on them help?
Sealing of primary molars
I had to advocate for my son’s provider to seal the remaining primary molars. They said they didn’t do it often in the initial teething. Some anecdotal rationales provided for this are:
- They are technique sensitive and usually require four-handed dentistry to place, which is not cost-effective.
- Some think they are going to exfoliate so it is not cost effective to do a traditional sealer.
- The data on their effectiveness is conflicting and they really don’t work to prevent tooth decay.
Even with these obstacles, our goal is to prevent tooth decay based on the available evidence. So, what are the most affordable options available today? A 2023 study of 3,000 children showed that over a two-year period, glass ionomer sealants prevented caries 82% of the time, and a drop of silver diaminofluoride (SDF) placed in the cavity and fissure sealants prevented 81% of caries.1
Watch more Hygiene Edge videos
He should know about the grading of periodontitis
Differences between 11/12 and 15/16 Gracey
Why SDF can work
Silver Diamine Fluoride (SDF) involves fewer steps than traditional sealants, naturally reducing the time required for placement. Watch the Hygiene Edge video with his steps to clean, rinse, dry, isolate, set and let soak for a minute, then put a fluoride varnish on top. One drop of fluoride varnish could also be used on an entire primary dentition. One drop of Advantage Arrest SDF is 84 cents and one drop of FluoriMax varnish is less than 22 cents per drop. If the pits and cracks have not caved in, then the area will not turn black. If, however, the treated area turns black, you’ve just arrested a lesion, preventing it from progressing, and that’s a win.
We know that traditional resin sealant application is very technique sensitive. Watch the installation video on Hygiene Edge with its steps for cleaning, rinsing, drying, isolation, etching, rinsing, drying, isolation, mounting, light curing, occlusion control/occlusion adjustment, and threading. Resin-based sealants are more time-consuming and technique-sensitive, but work to prevent tooth decay.
A study published in 2019 concluded that the incidence of caries between glass ionomer and resin-based sealants was not statistically significant.2 The big differences in glass ionomer sealants versus resin sealants is that glass ionomer is easier to place because no isolation is needed. With silver diamine fluoride costing less than other sealants, being less time-consuming to place, and having similar preventive effects, SDF may be a good alternative to a sealant in your practice.
Hygiene Edge was created by three dental hygiene educators who love both dentistry and education. With over 40 years of experience in both education and dentistry, Melia Lewis, Jessica Atkinson and Shelley Brown love to share their knowledge through useful, short online videos, speaking engagements and working with amazing companies. You can find more information at Health Edgeon YouTube, and Instagram @hygieneedge. Have a question or a difficult area? Let us know! We would like to help.
bibliographical references
- The school dental program prevents 80 percent of cavities with one-time, non-invasive treatment. Science Daily. February 10, 2023. https://www.sciencedaily.com/releases/2023/02/230210145811.htm
- Prathibha B, Reddy PP, Anjum MS, Monica M, Praveen BH. Sealants revisited: An efficacy battle between the two main types of sealants – A randomized controlled clinical trial. Dent Res J. 2019? 16 (1): 36-41.
